Health Equity Column, AAP Newsletter #4, All Bodies Are Good Bodies

As our children return to the community for another school year’s commencement, we will focus our next few Equity Columns on topics pertinent to this time of year.  This month, we want to highlight the importance of body-neutral speech and the Health at Every Size (HAES) movement.  A part of our job as pediatricians is to lay down a framework in childhood and adolescence for a continued positive and healthy relationship with our own bodies, nutrition, and physical activity to last the lifespan.

Weight stigma, also known as sizeism, is discrimination and stereotyping based on a person’s weight, size, and look. Weight-based discrimination is equal to that of other types of stigma, including that based on race, religion, sexuality,  or physical disability. Some examples of weight stigma include receiving negative comments or “health concerns” about weight from health care professionals, complimenting someone on their weight loss, or requiring someone to lose weight to receive a medical treatment. The incidence of weight stigma has increased by 66% alongside the rise of health campaigns to end the “obesity epidemic.” Whether in the community, at school, or during medical appointments, weight stigma causes suffering by promoting body dissatisfaction and has been linked to health care avoidance, low self-esteem, disordered eating, substance use, and even suicidality.

Pediatricians are vital in helping reduce weight stigma and supporting youth of all body compositions. Adopting a weight-inclusive approach in clinical practice is believing everybody is capable of achieving health and well-being, independent of weight.

Using the HAES framework, here are some ways to incorporate this model into clinical practice.

Weight Inclusivity:

Appreciating that our bodies come in all different shapes and sizes, minimize showing growth curves, and discussing weight/BMI. Focus on behaviors that impact health: eating, movement, sleep hygiene, and stress management.

Respectful Care:

Explore our own weight bias and work to end weight discrimination. Create a welcoming environment for all body types by having furniture that allows patients of all sizes to sit comfortably,  larger blood pressure cuff sizes, and privacy if it’s essential to measure a patient’s weight. Include body size diversity in all internal and patient-facing images and information. Inclusive imagery that embraces diversity, including size diversity, creates safe spaces and allows for equitable healthcare for all.

Health Enhancement:

Use supportive, compassionate, and non-stigmatizing communication with youth and their families. Instead of BMI, consider using different markers as an indicator of health. When counseling patients and families, consider their fasting lab values  (lipid panel, hemoglobin A1c, fasting glucose, ALT) and their unique life circumstances to support them with healthy living.

Eating for Well-being:

Promote eating for pleasure, hunger, satiety, and nutrition. Abstain from moralizing food (ie- food is either good or bad). Encourage intuitive eating.

Life Enhancing Movement:

Encourage individuals to engage in physical activities they genuinely enjoy, regardless of size or ability. Focus on the joy of movement rather than weight loss or specific fitness goals so that patients are more likely to sustain their engagement with activities in nature and reap holistic benefits

Resources and Recommendations

Take the weight implicit bias test:  https://implicit.harvard.edu

Rebecca Puhl, Rudd Center for Food Policy and Obesity, University of Connecticut, Addressing Weight Bias: Resources and Tools from the Rudd Center

https://uconnruddcenter.org/research/weight-bias-stigma/

Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):485-497.

https://www.nature.com/articles/s41591-020-0803-x

Podcast: What is weight stigma? With Dr Rebecca Puhl: Factually! With Adam Conover

https://podcasts.apple.com/us/podcast/factually-with-adam-conover/id1463460577?i=100050447440

A special thank you to my colleagues Dr Beatriz Mares and Dr Laurie Cammon, who lead our All Bodies are Good Bodies working group within our outpatient clinical setting at Santa Clara Valley Health system, for their assistance in penning this month’s column.  To discuss with them specifics on how we operationalize the material described in this column, please reach out to them directly at: beatriz.mares@hhs.sccgov.org and Laurie. Cammon@hhs.sccgov.org.